Imagine…

Research that may lead to revolutionary new therapies to treat cancer, Parkinson’s disease, Alzheimer’s disease, diabetes, spinal cord injury, heart disease, and many other debilitating conditions. Do the promises of stem cell research offer a realistic treatment or cure for these diseases?

A woman who does not want to, or who medically cannot, carry her fetus to term. Would she ever consider using a genetically modified cow possessing a human uterus as her surrogate? In the not too distant future, stem cell research may allow scientists to create such a human-animal chimera. What would be the risks of such a gestational scenario?

When there is a need to obtain histocompatible stem cells to treat a child who is ill, is it ethical to obtain and develop compatible embryonic stem cells from a pre-implanted embryo, knowing that the blastocyst will be destroyed in the process of deriving the desired stem cells?

While these scenarios may once have seemed like futuristic science fiction, advances in stem cell technology are bringing them closer to possibilities, if not to probabilities. In fact, desperate patients across the globe are traveling to countries such as China, Mexico, and the Dominican Republic to participate in unproven stem cell “therapies."

Bartolo Colón

Follow-up: Bartolo Colón during the 2011 season has an 8 and 9 record with an Earned Run Average (ERA) of 3.63.

Good examples inclcue sports figures such as Yankee baseball pitcher Bartolo Colon and tennis star Rafael Natal, who underwent an as yet unproven stem cell therapies to corrrect their injuries. Doctors extracted stem cells from Bartolo Colon's bone marrow and fatty tissue and transplanted them into his elbow and shoulder. After his recovery, he signed a new one-year, $900,000 contract with the Yankees and is back throwing pitches at 95 miles an hour. His resurgence has increased the demand for the controversial procedure that utilizes stem cells to treat injured athletes.

Recently, stem cell science has made rapid progress, revealing entirely new scientific opportunities that will enable the development of future treatments for a wide variety of medical conditions. Many of these experimental or medical breakthroughs will have an unprecedented societal impact. It is imperative to carefully evaluate these developments from diverse viewpoints including ethical, legal, religious, economic, cultural, political, as well as scientific perspectives. Together, these disciplines will shape both public policy and personal health decisions.

We believe that cell biologists, clinicians, and bio- and neuro-ethicists can work together to celebrate advances, while simultaneously helping to inform and protect patients and the broader community concerning what might be considered inappropriate or premature applications of novel stem cell technologies. This will not be an easy process. We must engage in ongoing reasoned and informed discourse to ensure safe and appropriate innovations and applications of this new technology.

Introduction

The fundamental science of pluripotent and multipotent stem cells will be the central theme of this Columbia University online course. Using a multidisciplinary approach, our aim is to provide a detailed exploration of the newest emerging scientific advancements and technologies in embryo and adult stem cell research, as well as an examination of actual and potential medical applications.

These modules were initially designed to accompany the Columbia University classroom course: "Stem Cells: Biology, Ethics, and Applications". We have now adapted the course to supplement any university course that focuses on stem cell research and potential medical and scientific applications. Undergraduate and graduate students as well as all others who have an interest in stem cell science, bioethical and social implications, and regulatory issues should find this course informative.

Within the eight Modules and Supplements of the online course, the reader will find:

This module presents the evolving landscape of bioethical implications of deriving human stem cells from the embryo, to induced pluripotent stem (iPS) cell technology, to cloning, and beyond.

Challenge: When does human life begin?

Case Study: Can a couple use pre-implantation genetics to produce a child whose bone marrow stem cells will be used to save the life of a sibling with Fanconi Anemia?

Supplement 2. Animal Rights and Welfare in the Context of Stem Cell Research

Case Study: Chimeras cross the boundaries of species. Should governments restrict the use of non-human primates in research if stem cells and genetic engineering technology are used to enhance human-like behaviors in these animals?

This module describes the use of stem cells to create human-animal chimeras in studies that have had a dramatic scientific impact on organ transplantation and organ regeneration. In addition, generating human-animal chimeras have elicited heated debates on the definition of human species and what makes human beings a unique organism.

Challenge: Is it ethical to reconstitute an animal with human neurons or human reproductive organs?

Case Study: Stem cell biology is constantly evolving. The public is finding it increasingly difficult to fully comprehend the risks and benefits of stem cell applications. How should physicians educate and advise desperate patients who want to participate either in long-range FDA approved clinical trials, that will take much time and may not benefit them, or immediately seek unproven “therapies” not offered in the US, in the hope of improving their paralysis?

Conclusion

While holding out great promise for improvements in health, treatment of disease, and increased understanding of the brain and other organs, rapidly advancing stem cell technologies raise compelling scientific, ethical, legal, and social concerns and questions.

Emerging stem cell science reflects a dynamic and often opposing balance between rapidly progressing and diverse scientific discoveries, and a host of bioethical and societal concerns. Important issues are raised at every level and stage of research, from manipulating a somatic cell into a stem cell, to enrolling a patient in a stem cell clinical trial, to educating legislators and the public. We hope readers of this on-line course will have their curiosity stimulated by the myriad of important and complex ideas raised, and carefully consider the ethical dilemmas generated by stem cell science.

"Stem Cells: Biology, Bioethics, and Applications" is supported by a grant from the New York State STEM Cell Initiative (NYSTEM). It provides information on a range of important and complex topics about stem cell science. We believe students, professors, health care professionals, and the public alike will find the online multidisciplinary course on the current and future research of stem cell technologies and its applications informative and stimulating. The content of this online course was written and prepared by John D. Loike, Ph.D., Director of Special Programs, Center for Bioethics, Columbia University and Ruth L. Fischbach, Ph.D. M.P.E., Director, Center for Bioethics, Columbia University with special assistance from Janet Mindes, Ph.D., Consultant, Center for Bioethics, Columbia University.